Provider Demographics
NPI:1063670867
Name:PUGLIESE, THERESA (PNP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:PUGLIESE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1063
Mailing Address - Country:US
Mailing Address - Phone:732-684-0334
Mailing Address - Fax:
Practice Address - Street 1:176 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1063
Practice Address - Country:US
Practice Address - Phone:732-684-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09065300363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics